OBJECTIVE: We were determined to develop robotic cardiac surgery to the point where we used only ports and all percutaneous cannulation.METHODS: We have done 50 patients thus far using all percutaneous cannulation. All patients underwent mitral valve repair using 4 da vinci 8mm ports and a 12 mm working port. All patients underwent percutaneous cannulation using ultrasound, fluoroscopy, and TEE guidance. Most patients were done with the endoballoon.RESULTS:We have no deaths or major vascular complications. We did have one plaque lifted in the femoral which required cutdown and repair without sequela. The average length of stay was 4 days but the last 25 patients have had an average length of stay of 3 days.CONCLUSIONS:All percutaneous cannulation combined with a totally endoscopic robotic approach allows mitral valve surgery to be done with a 12 mm port as the large incision in the body, facilitating fewer groin complications, less pain, and earlier discharge.